Finding a Private Caregiver for Your Loved One:
Consider Your Three Options Carefully
By
Marc Spector
An August 2013 study published by the AARP Public Policy Institute concluded that the supply
of family caregivers is unlikely to keep pace with future demand in America. The study found that the
number of potential adult family caregivers for each American over the age of 80 is expected to plunge
from seven potential caregivers in 2010 to just four potential caregivers by 2030 and then down to as few
as three potential caregivers by 2050.
This looming “caregiver crisis” is largely the result of fundamental changes in the age and
makeup of the families in our country. Two out of every five American adults are caring for an older
loved one who is aging in place, a number that continues to increase each year as the demographics shift
toward an aging population. Moreover, the number of elderly Americans suffering from Alzheimer’s
disease has continued to rise in recent years, compounding this need for full-time care of elderly loved
ones.
Finding a Private Caregiver
For families that are faced with the painful challenge of finding in-home care for an aging parent
or other family member, the options for locating those caregivers can be confusing and difficult to
navigate. The first term a family needs to embrace is the notion of “private duty care”; this is the kind of
care that consumers need to seek out for elderly loved ones who are unable to get around or take care of
themselves without some assistance.
The concept of private duty care has been around for many years and basically refers to in-home
care that is paid for directly by the consumer or their long-term care insurance policy -- not Medicare or
commercial health insurance. This care can either be provided by a home care agency, an individual
caregiver whom a consumer finds online or through some other informal means, or a third option that
combines the best of both models: a professional referral from a private duty caregiver registry.
The first option of finding home care through an agency – a company that hires caregivers –
provides a good mechanism for obtaining quality caregivers whose credentials have been verified.
However, this is often the most expensive model due to the increased overhead of an employee-based
business structure.
For example, an agency must pay half the cost of Medicare and Social Security taxes for their
caregiver employees (i.e., FICA taxes), which makes the cost of hiring a caregiver from an agency that
Private Care Association, Inc., PO Box 0911, Southern Pines, NC 28388-0911, (855) 722-0911, www.privatecare.org
much more expensive; the same thing is true with respect to workers’ compensation insurance and
unemployment taxes. In addition, new labor laws passed at both the federal level and in some states now
require home care agencies to pay their employee caregivers overtime, raising the wages that must be
paid by agencies and further increasing the rate they must therefore charge families for caregivers.
Moreover, obtaining private duty care from an agency is about to become even more costly due to
requirements from the Affordable Care Act (“ObamaCare”), which has imposed a number of new
financial burdens on employers to provide health insurance benefits for their employees.
The second option of hiring an “underground” caregiver by consulting Craigslist or some other
online directory is often the least expensive avenue for obtaining in-home care. However, this approach is
fraught with a wide range of risks since there are no consumer protections, professional credentialing
requirements or background checks on the caregivers. For example, it is much more difficult to verify
how much prior hands-on work experience a candidate has as a caregiver, or if they have any nursing
certifications or training certificates. It’s also very difficult for a family to independently confirm the
caregiver is eligible to work in the U.S., whether they have any sort of criminal history or professional
disciplinary citations in their background, or even if they have had proper medical checks to make sure
they are not carrying any communicable diseases. These are all serious and important risks that a family is
taking when they choose to hire a caregiver “underground” through some private arrangement.
The Third Option: A Caregiver Registry
The third option -- and the original model for home care -- combines the best of both worlds. A
caregiver registry is a company that refers self-employed caregivers to consumers on a private basis, for
care needed anywhere from a few hours at a time up to 24 hours a day. The registry provides
administrative support to the consumer and access to caregivers that have been pre-screened prior to
entering the client’s home.
There are three things that most families want when they set out to find a private in-home
caregiver for their elderly loved one: a caregiver who is trustworthy; to be protected in case something
goes wrong in the home; and to be protected in case someone is dishonest. Registries address all three of
these concerns because of clear guidelines that are established and promoted by the Private Care
Association (PCA), the national association for private duty home care registries and referral agencies
since 1977. PCA member registries conduct background checks, verify credentials and check the
professional references of caregivers before they are referred to consumers. This ensures that only the
very best, qualified caregivers are referred to a family in order to meet their unique needs.
At the same time, since the caregivers are self-employed, a caregiver registry can save families
anywhere from 10 to 30 percent on their in-home care expenses. This is because registries take significant
costs out of the business that are created by the agency model – ranging from additional tax obligations to
increased employee benefit expenses – and returns those cost savings to families in the way of reduced
caregiver rates.
Private Care Association, Inc., PO Box 0911, Southern Pines, NC 28388-0911, (855) 722-0911, www.privatecare.org
The end result of the registry model is to provide the consumer with safe access to a private duty
caregiver at a more affordable cost.
Conclusion
In the end, the delivery of care is similar between an agency and a registry. The primary factors
for a consumer deciding on how to obtain in-home care for an elderly loved one comes down to price and
the quality of the caregiver. Caregivers who are referred to consumers by PCA member registries carry
their own liability insurance to cover the rare occurrence of an accident in the home.
A caregiver registry not only allows caregivers the opportunity to earn more wages than they would
working for an agency, it also affords families to obtain the same high-quality care for their loved ones
and – in many instances – at a more affordable price.
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About the Author
Marc Spector is president of Best Care (www.bestcare.net), a state-licensed nurse registry that refers
high-quality, personalized home-health caregivers to Florida families. Best Care is a member of Private
Care Association (PCA), the national association for private duty home care registries and referral
agencies. The PCA promotes the individual rights of the consumer and protects the interests of today's
caregiver. For more information, please go to www.privatecare.org.
Private Care Association, Inc., PO Box 0911, Southern Pines, NC 28388-0911, (855) 722-0911, www.privatecare.org